Femoral head press instrument for prosthetic implant

ABSTRACT

A femoral head press can comprise: a frame having first end second ends; a clamp connected to the first end to define a holding plane; a mechanical drive mechanism mounted to the second end and having a drive axis; a ram connected to the second end; and a femoral head cup connected to the ram; wherein the mechanical drive mechanism is configured to drive the ram along the drive axis substantially perpendicular to the holding plane to advance the femoral head cup toward the clamp. A method for assembly a femoral head to a stem neck can comprise: attaching a clamp of a frame of a femoral head press to a neck of a femoral stem; connecting a femoral head to a cup connected to a ram slidably engaged with the frame; and actuating a mechanical drive mechanism coupled to the frame to advance the cup toward the neck.

CLAIM OF PRIORITY

This application claims the benefit of U.S. Provisional PatentApplication Ser. No. 62/334,519, filed on May 11, 2016, the benefit ofpriority of which is claimed hereby, and which is incorporated byreference herein in its entirety.

TECHNICAL FIELD

This document pertains generally, but not by way of limitation, tosurgical instruments for implanting prosthetic devices. Moreparticularly, this disclosure relates to, but not by way of limitation,instruments for aligning and assembling components of a prostheticdevice.

BACKGROUND

Surgery to replace the femoral portion of a hip joint in total jointsurgery can involve the insertion of a stem in a cavity formed in thefemur. The end of the stem extending from the cavity has a neck which isformed at an angle, and a ball disposed on the neck is mated with asocket in the hip. Patients can require individual fitting of theimplant due to the unique anatomical requirements of each particularpatient. Some prosthetic implants can be unitary in nature, wherein thefemoral stem and the ball are made from the same component. However,such unitary devices can require the hospital or surgeon to have a largequantity of prostheses available in order to be able to provide acorrect fit for each patient. It can be very costly to maintain a largeinventory of unitary prostheses. Furthermore, despite having a largenumber of unitary prostheses to choose from, an optimally fittingprosthetic cannot always be found. This leaves the surgeon to use thebest fitting prosthetic available, which may result in discomfort forthe patient.

More recently, modular prostheses have been designed to overcome thislongstanding problem. Exemplary modular prostheses are described in U.S.Pat. No. 5,015,257 to Crowninshield et al., U.S. Pat. No. 8,562,690 toDickerson, and U.S. Pub. No. 2008/0167723 to Acker et al. Theseprostheses, however, can result in the surgeon needing tointraoperatively align and connect various components. Typically, asurgeon is left to manually assemble the various components usingdifferent holding devices and a mallet or hammer to apply the desiredassembly force. Due to differences between surgeons and each particularpatient, these procedures can result in considerable variation in thefinal implanted prosthetic. Such procedures are described in U.S. Pat.No. 6,974,483 to Murray and U.S. Pub. No. 2003/0229357 to Dye.

Examples of various surgical instruments are described in U.S. Pat. No.5,133,765 to Cuilleron, U.S. Pat. No. 8,123,754 to Siebel et al., U.S.Pub. No. 2010/0152742 to Nevelos et al., U.S. Pub. No. 2011/0004318 toTulkis et al., and U.S. Pub. No. 2011/0071534 to Tuke.

OVERVIEW

The present inventors have recognized, among other things, that aproblem to be solved can include the need for surgeons to have tomanually align one prosthetic component with another and subsequently,while maintaining alignment, impact one of the components tomechanically couple the components together. This situation can beparticularly difficult in the context of assembling a femoral head orball onto a femoral stem neck. The present inventors have recognizedthat the force delivered by various surgeons can widely vary and may notreach a desired force to correctly seat the ball on the neck. Thepresent inventors have recognized that improperly impacted femoral headscan result in fretting corrosion in vivo, which may produce deleteriousresults, such as patient pain, adverse tissue reactions, pseudo tumorsand the like.

The present subject matter can help provide a solution to this problem,such as by providing the surgeon with a surgical instrument that alignsthe femoral head with the neck, and that utilizes a mechanical advantageto assemble the head onto the neck in the desired orientation and withthe desired force, thereby inhibiting or preventing fretting corrosionand other deleterious results.

A femoral head press can comprise: a frame having a first end and asecond end; a clamp connected to the first end of the frame, the clampdefining a holding plane; a mechanical drive mechanism mounted to thesecond end of the frame, the mechanical drive mechanism having a driveaxis; a ram connected to the second end of the frame; and a femoral headcup connected to the ram; wherein the mechanical drive mechanism isconfigured to drive the ram along the drive axis substantiallyperpendicular to the holding plane to advance the femoral head cuptoward the clamp.

A method for assembly a femoral head to a stem neck of a prostheticdevice can comprise: attaching a clamp of a frame of a femoral headpress to a neck of a femoral stem; connecting a femoral head to a cupconnected to a ram slidably engaged with the frame; and actuating amechanical drive mechanism coupled to the frame to advance the ram andcup toward the neck.

This overview is intended to provide an overview of subject matter ofthe present patent application. It is not intended to provide anexclusive or exhaustive explanation of the invention. The detaileddescription is included to provide further information about the presentpatent application.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is a side schematic view of a femoral head press having a framethat attaches to a stem neck and a mechanical press comprising athreaded ram.

FIG. 1B is a broken away bottom view of the femoral head press of FIG.1A showing a clamp mechanism attaching the frame to the stem neck.

FIG. 1C is a side cross-sectional view of the clamp mechanism of FIG. 1Bshowing an insert providing a buffer between the clamp mechanism and thestem neck.

FIGS. 2A-2C are top, side and front views of the insert of FIG. 1C.

FIG. 3 is a side schematic view of the femoral head press of FIG. 1Ahaving a motor attached to the threaded ram.

FIG. 4 is a side schematic view of a femoral head press having a framethat attaches to a stem neck and a mechanical press comprising a gearedram.

FIG. 5 is a side schematic view of a femoral head press having a framethat attaches to a stem neck and a mechanical press comprising amotor-driven geared ram system.

In the drawings, which are not necessarily drawn to scale, like numeralsmay describe similar components in different views. Like numerals havingdifferent letter suffixes may represent different instances of similarcomponents. The drawings illustrate generally, by way of example, butnot by way of limitation, various embodiments discussed in the presentdocument.

DETAILED DESCRIPTION

FIG. 1A is a side schematic view of femoral head press 10 connected toprosthetic stem 12. Femoral head press 10 can include frame 14,mechanical press 16 and clamp mechanism 18. Prosthetic stem 12 caninclude shank 19, neck 20 and head 21. Shank 19 of stem 12 can beinserted into cancellous bone of a femur (not shown) in a manner so thatneck 20 extends from a resected proximal end of the femur when thenatural or anatomic femoral head is removed. Neck 20 can extend fromshank 19 along neck axis A_(N). Head 21 can be a separate component thatcan be assembled to neck 20 with the use of femoral head press 10.

Frame 14 can comprise a rigid body that can fixedly support mechanicalpress 16 relative to clamp mechanism 18. In various examples, frame 14can be fabricated from a stainless steel, such as 417 stainless steel.Support end 22 of frame 14 can extend in a plane generally (e.g., within+/− five degrees) perpendicular to axis A_(N). Bridge portion 24 offrame 14 can extend away from support end 22 to position drive end 26opposite support end 22. Drive end 26 can extend in a plane generally(e.g., within +/− five degrees) perpendicular to drive axis A_(D). Assuch, rigidity provided by frame 14 can help ensure that drive axisA_(D) of mechanical press 16 aligns with clamp mechanism 18 and neckaxis A_(N) to facilitate assembly of head 21 to neck 20.

Support end 22 of frame 14 can be connected to neck 20 via clampmechanism 18. Clamp mechanism 18 can include locking device 28 andtensioning device 30. Clamp mechanism 18 can comprise clamp or collar 32that can allow support end 22 of frame 14 to open to accept neck 20, asdiscussed below with reference to FIG. 1B. Collar 32 can be disposed ina plane substantially (e.g., within +/− five degrees) parallel toholding plane P. Locking device 28 can include fastener 34 that allowscollar 32 to be tightly closed around neck 20. Similarly, tensioningdevice 30 can include fastener 36 that facilitates insert 50 (FIGS.2A-2C) being centered along axis A_(N) and tightening of insert 50 onneck 20.

Mechanical press 16 of frame 14 can be connected to drive end 26 offrame 14. In the embodiment of FIG. 1A, mechanical press 16 comprisesram 38, which can comprise shaft 40, knob 42 and cup 44. Drive end 26 offrame 14 can include bore 46 that can be configured to receive shaft 40.In an example, shaft 40 and bore 46 can include mating threads thatallow ram 38 to be advanced and retreated along drive axis A_(D). In anexample, the threads can be box threads that facilitate easy torquetransmission between shaft 40 and bore 46. Knob 42 can be attached to aproximal end of shaft 40 to facilitate rotation of shaft 40. In anexample, knob 42 can be a hex head to allow knob 42 to mate with awrench. In various examples, ram 38 can be fabricated from a stainlesssteel, such as 304 stainless steel. Cup 44 can be attached to a distalend of shaft 40 to facilitate coupling with femoral head 21.

FIG. 1B is a broken away bottom view of femoral head press 10 of FIG. 1Ashowing clamp mechanism 18 attaching frame 14 to stem neck 20. FIG. 1Cis a side cross-sectional view of clamp mechanism 18 of FIG. 1B showinginsert 50 providing a buffer between clamp mechanism 18 and stem neck20.

Frame 14 can include support end 22 extending from bridge portion 24(FIG. 1A). Clamp mechanism 18 can include locking device 28 and collar32. Collar 32 can include jaws 48A and 48B, and insert 50. Jaw 48A canbe integral with support end 22 and jaw 48B can be connected to supportend 22 with a fastener at pivot 52. Insert 50 can be connected tosupport end 22 via a fastener, such as pin 54. Clamp mechanism 18 caninclude fastener 34, head 56, shank 58 and nut 60. Nut 60 can be removedfrom shank 58 of fastener 34 in order to allow jaw 48B to be rotatedaway from support end 22 at pivot 52 on pin 62. With jaw 48B rotatedaway, insert 50 and stem 12 can be positioned within collar 32. Insert50 can be coupled to support end 22 via pin 54 and can be snapped intoengagement with jaws 48A and 48B.

FIGS. 2A-2C are top, side and front views of insert 50 of FIG. 1C.Insert 50 can include collet portion 64 and extension portion 66. Colletportion 64 can include first arm 68A, second arm 68B, split 70, socket72, first channel 74A, second channel 74B and aligned bores 76A and 76B.Extension portion 66 can include bore 78.

Socket 72 can be shaped to engage neck 20. Socket 72 can have differentshapes for different implants to be assembled with press 10. Thus, inone example, forward surface 78 can be curved while rear surface 80 canbe flat. Split 70 can be included in collet portion 64 to facilitateassembly of insert 50 with neck 20. Insert 50 can be made of a resilientmaterial to engage with neck 20. In various examples, insert 50 can bemade of nylon, silicon, Raydel® or the like. Insert 50 protects neck 20against damage from clamp 32 and also facilitates aligning of neck 20with shaft 40. Additionally, insert 50 allows femoral head press 10 tobe used with a variety of different prosthetic implants. For example,the interior surfaces of insert 50 that form socket 72, such as forwardsurface 78 and rear surface 80, can be shaped differently for differentimplants, while the exterior surfaces, such as those forming channels74A and 74B, can be the same for every implant.

The back of insert 50 can engage support end 22 using extension portion66. Specifically, extension portion 66 can be angled out from colletportion 64 to lie flush against support end 22. Pin 54 can be insertedthrough bore 78 and into bore 81 in support end 22 to hold extensionportion 66 in place. Extension portion 66 and pin 54 can be configuredto simultaneously engage stem 12. For example, extension portion 66 canbe sandwiched between a surface of stem 12 and support end 22, with pin54 extending through extension portion 66 and into both bore 81 and bore83 (FIG. 1A) of stem 12.

The sides of insert 50 can engage support end 22 using channels 74A and74B. Specifically, arms 68A and 68B can include channels 74A and 74B,respectively, to engage with jaws 48A and 48B of collar 32, therebycapturing insert 50 within collar 32. Channels 74A and 74B and jaws 48Aand 48B can be sized and shaped to provide an interference fit thatsnaps and holds insert 50 into place on support end 22.

The front of insert 50 can engage support end 22 of frame 14 usingaligned bores 76A and 76B. Specifically, arms 68A and 68B can alsoinclude aligned bores 78A and 78B to receive shaft 58 of fastener 34. Inother examples, arms 68A and 68B can include front end flanges thatextend from arms 68A and 68B toward each other to further retain insert50.

Thus, inset 50 can be positioned in collar 32 so that jaws 48A and 48Bengage channels 74A and 74B, respectively. Jaw 48B can be rotated backinto engagement with insert 50 and shaft 58 can be inserted into boresin jaws 48A and 48B and aligned bores 76A and 76B. Nut 60 can bethreaded onto shaft 58 to tighten insert 50 into place. Insertion of pin54 into bore 78 and aligned bore 81 in support end 22 can hold insert 50in place.

As can be seen in FIG. 1C, fastener 36 of tensioning device 30 can bethreaded into bore 62 in support end 22. Bore 62 and fastener 36 canhave mating threads that allow fastener 36 to push against insert 50.Thus, with fastener 34 and pin 54 in place, and neck 20 inserted intosocket 72, fastener 36 can be advanced to push neck 20 into alignmentwith shaft 40. In particular, positioning of insert 50 by fastener 36can help align neck axis A_(N) with drive axis A_(D). Also, becauseinsert 50 can be soft and resilient, neck 20 can remain unblemished andundamaged. Insert 50 can be plastically deformed during use and canthus, in some embodiments, be a one-time use, disposable component.

After press 10 has been assembled to stem 12, femoral head 21 can beconnected to cup 44. Cup 44 can include cavity 82 that conforms to theouter surface of head 21. Cup 44 can thus be shaped so that head 21 fitswithin cavity 82 in only one way so that socket 84 is centered on driveaxis A_(D). In other words, head axis AH can align with drive axis A_(D)when head 21 is properly seated in cup 44. Different sized cups can bemounted to shaft 40 for use with different sized heads. Thus, cup 44 canbe connected to shaft 40 using means that allow for repeated, releasableengagement, such as a threaded connection. In an example, cup 44 canalso include fingers 86 that can flex to allow head 21 to be inserted incavity 82, but that grab onto head 21 to hold head 21 in only oneorientation. For example, fingers 86 can engage a flat bottom surface ofhead 21 that faces towards collar 32.

Next, mechanical press 16 can be operated to advance shaft 40 towardcollar 32. In one example, femoral head press 10 can be manuallyoperated and supported, e.g., manually held and manipulated. Knob 42 canbe manually rotated or a tool can be attached to knob 32 to facilitaterotation of shaft 40. For example, knob 42 can be a hex head to engage acorrespondingly sized wrench. Handle 88 can also be grasped in order togain leverage in rotating shaft 40 and to facilitate balancing of frame14 relative to stem 12. Because drive axis A_(D) is aligned with neckaxis A_(N), head 21 can be advanced properly into position on neck 20.In another example, femoral head press can be supported by a stand thatpositions femoral head press 10 relative to the anatomy of the patientand then subsequently manually operated. However, as discussed below,various femoral head presses of the present disclosure can be operatedunder external power.

FIG. 3 is a side schematic view of femoral head press 10 of FIG. 1Ahaving motor 90 attached to mechanical press 16. Femoral head press 10of FIG. 3 includes the same components as those shown and described withreference to FIG. 1A. However, motor 90 can be attached to frame 14 inorder to automate the rotation of shaft 40. Motor 90 can include housing92, which can be coupled to frame 14 via mounting bracket 94. Mountingbracket 94 can be connected to housing 92 and frame 14 by any suitablemeans, such as fasteners, welding or the like. Motor 90 can also includedrive shaft 96, which can be connected to shaft 40 via any suitablemeans. For example, drive shaft 96 can be directly welded to shaft 40 asshown in FIG. 3 such that knob 42 can be omitted. In other examples,drive shaft 96 can coupled to knob 42 via a socket (not shown) or someother mechanical interaction. Motor 90 can include activation button 98that can be depressed to commence rotation of drive shaft 96. Motor 90can be activated by any suitable power source. For example, motor 90 canbe an electric motor or a pneumatic motor. Motor 90 can be powered by aninternal power source, such as a battery, or an external power source,such as a power cord connected to an electrical outlet or an air hoseconnected to a source of compressed air. Motor 90 can allow a surgeon oroperator of femoral head press 10 to automatically and precisely controlplacement of head 21. Thus, the surgeon can concentrate on monitoringengagement of head 21 with stem 20 and the rest of the surgicalprocedure, rather than being distracted by operation of mechanical press16.

FIG. 4 is a side schematic view of femoral head press 100 having frame102 that attaches to stem neck 20 and mechanical press 104 comprisinggeared ram 106. Femoral head press 100 can also include clamp mechanism108. Prosthetic stem 12 includes shank 19 (FIG. 1A), neck 20 and head21. Shank 19 of stem 12 can be inserted into cancellous bone of a femur(not shown) in a manner so that neck 20 extends from a resected proximalend of the femur wherein the natural or anatomic femoral head isremoved. Neck 20 can extend from shank 19 along neck axis A_(N).

Frame 102 can be of similar construction as that of frame 14 of FIG. 1A.Likewise, clamp mechanism 108 can include collar 110 that operates in asimilar fashion as that of clamp mechanism 18 and collar 32 of FIG. 1A.For example, collar 110 can include locking device 112, tensioningdevice 114 and insert 116. Further description is not provided hereexcept to say that collar 110 can align neck axis A_(N) with drive axisA_(D) as has been previously described. Head 21 can be attached to cup118. Cup 118 can be of similar construction as cup 44 of FIG. 1A.

Geared ram 106 can include lever arm 120, gear 122, pin 124, shaft 126,and sleeve 128. Sleeve 128 can be inserted into bore 130 in frame 102,and shaft 126 can be inserted into channel 132 in sleeve 128. Sleeve 128can act as a bushing or bearing surface to facilitate sliding of shaft126 within frame 102. Shaft 126 can include gear teeth 134 that aresized and shaped to mesh with gear teeth 136 on gear 122. First end 138of arm 120 and gear 122 can be pinned to frame 102 via pin 124. Firstend 138 and gear 122 can be attached so that gear 122 can rotate aboutpin 124 while arm 120 can simultaneously pivot at pin 124. Gear 122 andfirst end 138 can be immobilized with reference to frame 102 via pin124. In other words, gear teeth 136 can orbit or rotate around pin 124as second end 140 of arm 120 is moved about an arc. When arm 120 isrotated up (with reference to the orientation of FIG. 4), gear 122 canrotate counterclockwise to push shaft 126 downward toward neck 20through engagement of gear teeth 136 with gear teeth 134. When arm 120is rotated down (with reference to the orientation of FIG. 4), gear 122rotates clockwise to push shaft 126 upward away from neck 20 throughengagement of tear teeth 136 with gear teeth 134. Frame 102 can includea slot (not shown) that receives arm 120 and that allows arm 120 torotate about pin 124. Frame 102 can include handle 142 that facilitatesgrasping and balancing of femoral head press 100 and actuation of leverarm 120.

FIG. 5 is a side schematic view of femoral head press 150 having frame152 that attaches to stem neck 20 (FIG. 4) and mechanical press 154comprising motor-driven geared ram system 156. Femoral head press 150can also include clamp mechanism 158 and motor 160.

Frame 152 can be of similar construction as that of frame 102 of FIG. 4.Likewise, clamp mechanism 158 can include collar 162 that operates in asimilar fashion as that of clamp mechanism 108 and collar 110 of FIG. 4.For example, collar 162 can include locking device 164, tensioningdevice 166 and insert 168. Further description is not provided hereexcept to say that collar 162 aligns neck axis A_(N) with drive axisA_(D) as has been previously described. Head 21 (FIG. 4) can be attachedto cup 170. Cup 170 can be of similar construction as cup 118 of FIG. 4.

Motor-driven geared ram system 156 can include first gear 172 and secondgear 174, which can be mounted on pins 176 and 178, respectively. Assuch, gears 172 and 174 are stationary with respect to frame 152, butare free to rotate about pins 176 ad 178.

Motor 160 can include housing 180, which can be coupled to frame 150 viamounting bracket 182. Mounting bracket 182 can be connected to housing180 and frame 150 by any suitable means, such as fasteners, welding orthe like. Motor 160 can also include drive shaft 184, which can beconnected to worm gear 186 via any suitable method. For example, driveshaft 184 can be directly welded to worm gear 186 as shown in FIG. 5. Inother examples, drive shaft 184 can coupled to worm gear 186 via asocket (not shown) or some other mechanical interaction. Motor 160 caninclude activation button 188 that can be depressed to commence rotationof drive shaft 184. Motor 160 can be activated by any suitable powersource. For example, motor 160 can be an electric motor or a pneumaticmotor. Motor 160 can be powered by an internal power source, such as abattery, or an external power source, such as a power cord connected toan electrical outlet or an air hose connected to a source of compressedair.

Operation of motor 160, in an example, can allow for rotation of driveshaft 184 in forward and reverse directions. In a forward direction,drive shaft 184 can rotate to cause clockwise rotation of first gear 172via engagement of gear teeth 190 on worm gear 186 with gear teeth 192 onfirst gear 172. Clockwise rotation of first gear 172 can causecounterclockwise rotation of second gear 174 via engagement of gearteeth 192 with gear teeth 196 of second gear 174. Counterclockwiserotation of second gear 174 can cause downward (with respect to theorientation of FIG. 5) movement of shaft 198 of mechanical press 154 viaengagement of gear teeth 196 with gear teeth 200 of shaft 198. Thus, cup170 can be advanced toward collar 158 with drive axis A_(D) aligned withneck axis A_(N).

In a reverse direction, drive shaft 184 can rotate to causecounterclockwise rotation of first gear 172 and clockwise rotation ofsecond gear 174, which can cause upward (with respect to the orientationof FIG. 5) movement of shaft 198 of mechanical press 154 to withdraw cup170 away from collar 158.

Motor 160 can allow a surgeon or operator of femoral head press 150 toautomatically and precisely control placement of head 21 (FIG. 1A).Thus, the surgeon can concentrate on monitoring engagement of head 21with neck 20 and the rest of the surgical procedure, rather than beingdistracted by operation of mechanical press 154.

Any of the femoral head presses described herein are beneficial inachieving proper alignment and assembly between head 21 and neck 20.Without proper alignment and assembly, the junction between head 21 andneck 20 can experience fretting corrosion in vivo which may producedeleterious products that result in pain, adverse tissue reactions,pseudo tumors, etc. Several factors, including impaction load,misalignment, materials combinations, tolerances, head diameter havebeen postulated to affect the extent of the fretting corrosion. Thefemoral head presses described herein can allow for the seating of head21 onto neck 20 in a consistent and reproducible manner to reduce oreliminate surgeon-to-surgeon variability, which subsequently can reduceor eliminate fretting corrosion. The femoral head presses describedherein can allow femoral head 21 to fully seat on neck 20 as intended,e.g. wherein neck axis A_(N) is aligned with the axis of head 21, andhead 21 is pushed onto neck 20 with the proper amount of force, therebyremoving the variation that may occur from surgeons using a mallet toseat head 21.

Each of the femoral head presses described herein use a mechanicalloading force to seat femoral head 21 uniformly onto neck 20. Thefemoral head presses can include a machine or device that utilizes amechanical advantage (e.g., gears, levers, motors, torque transmission,pneumatics), to allow the surgeon to apply the appropriate amount offorce, with little effort (e.g. without the need for swinging a hammeror mallet). The device can be repeatedly moved along a single loading ordrive axis A_(D). The femoral head 21 can be attached to the deviceusing a cup that ensures the head axis AH is aligned with the drive axisA_(D). The device can be attached to prosthetic stem 12 via a framehaving a clamp mechanism that ensures the neck axis A_(N) is alignedwith the drive axis A_(D), thereby ensuring alignment of the neck axisA_(N) with the head axis AH when femoral head 21 is in the cup. Theframe can be used manually or can be used in conjunction with a standthat would allow the surgeon to more easily manipulate the femoral headpress with the least effect on the patient.

VARIOUS NOTES & EXAMPLES

Example 1 can include or use subject matter such as a femoral head pressthat can comprise: a frame having a first end and a second end; a clampconnected to the first end of the frame, the clamp defining a holdingplane; a mechanical drive mechanism mounted to the second end of theframe, the mechanical drive mechanism having a drive axis; a ramconnected to the second end of the frame; and a femoral head cupconnected to the ram; wherein the mechanical drive mechanism isconfigured to drive the ram along the drive axis substantiallyperpendicular to the holding plane to advance the femoral head cuptoward the clamp.

Example 2 can include, or can optionally be combined with the subjectmatter of Example 1 to optionally include, a clamp that can include acollar for attaching to a neck of a femoral stem, wherein the clamp isconfigured to hold a center of the neck at the drive axis.

Example 3 can include, or can optionally be combined with the subjectmatter of one or any combination of Examples 1 or 2 to optionallyinclude, a clamp that can include an insert for buffering against thecollar.

Example 4 can include, or can optionally be combined with the subjectmatter of one or any combination of Examples 1 through 3 to optionallyinclude an insert that can be made of a resilient material.

Example 5 can include, or can optionally be combined with the subjectmatter of one or any combination of Examples 1 through 4 to optionallyinclude an insert that cab be captured in the collar.

Example 6 can include, or can optionally be combined with the subjectmatter of one or any combination of Examples 1 through 5 to optionallyinclude a clamp that can open to accept the insert.

Example 7 can include, or can optionally be combined with the subjectmatter of one or any combination of Examples 1 through 6 to optionallyinclude a clamp that can include a tensioner that pushes the insertwithin the holding plane within the collar.

Example 8 can include, or can optionally be combined with the subjectmatter of one or any combination of Examples 1 through 7 to optionallyinclude a clamp that can include a first fastener for closing thecollar.

Example 9 can include, or can optionally be combined with the subjectmatter of one or any combination of Examples 1 through 8 to optionallyinclude, a frame that can include a balance handle spaced from themechanical drive mechanism.

Example 10 can include, or can optionally be combined with the subjectmatter of one or any combination of Examples 1 through 9 to optionallyinclude a femoral head cup that can include fingers.

Example 11 can include, or can optionally be combined with the subjectmatter of one or any combination of Examples 1 through 10 to optionallyinclude a mechanical drive mechanism that can include a machine thatproduces a mechanical advantage.

Example 12 can include, or can optionally be combined with the subjectmatter of one or any combination of Examples 1 through 11 to optionallyinclude a mechanical drive mechanism that can include a motor.

Example 13 can include, or can optionally be combined with the subjectmatter of one or any combination of Examples 1 through 12 to optionallyinclude a mechanical drive mechanism that can comprise a threadedengagement between the frame and the ram, and the ram further comprisesa knob.

Example 14 can include, or can optionally be combined with the subjectmatter of one or any combination of Examples 1 through 13 to optionallyinclude a mechanical drive mechanism that can comprise: a lever armhaving a first end and a second end, the first end coupled to the frameand the second end extending from of the frame; a toothed gear coupledto the first end of the lever arm; and a gear tooth track extendingalong the ram.

Example 15 can include, or can optionally be combined with the subjectmatter of one or any combination of Examples 1 through 14 to optionallyinclude, a mechanical drive mechanism that can comprise: a motor havinga worm gear; a gear system; and a gear tooth track extending along theram.

Example 16 can include or use subject matter such as a method forassembling a femoral head to a neck of a femoral stem of a prostheticdevice, the method comprising: attaching a clamp of a frame of a femoralhead press to a neck of a femoral stem; connecting a femoral head to acup connected to a ram slidably engaged with the frame; and actuating amechanical drive mechanism coupled to the frame to advance the ram andthe cup toward the neck.

Example 17 can include, or can optionally be combined with the subjectmatter of Example 16 to optionally include actuating the mechanicaldrive mechanism that can comprise rotating a threaded ram to advance theram and the cup toward the neck.

Example 18 can include, or can optionally be combined with the subjectmatter of one or any combination of Examples 16 or 17 to optionallyinclude actuating the mechanical drive mechanism that can compriserotating a lever connected to a toothed ram to advance the ram and thecup toward the neck.

Example 19 can include, or can optionally be combined with the subjectmatter of one or any combination of Examples 16 through 18 to optionallyinclude actuating a motor to operate the mechanical drive mechanism andadvance the ram and the cup toward the neck.

Example 20 can include, or can optionally be combined with the subjectmatter of one or any combination of Examples 16 through 19 to optionallyinclude attaching the clamp of the frame of the femoral head press tothe neck of the femoral stem that can comprise positioning an insertwithin the clamp to align the neck with the ram.

Each of these non-limiting examples can stand on its own, or can becombined in various permutations or combinations with one or more of theother examples.

The above detailed description includes references to the accompanyingdrawings, which form a part of the detailed description. The drawingsshow, by way of illustration, specific embodiments in which theinvention can be practiced. These embodiments are also referred toherein as “examples.” Such examples can include elements in addition tothose shown or described. However, the present inventors alsocontemplate examples in which only those elements shown or described areprovided. Moreover, the present inventors also contemplate examplesusing any combination or permutation of those elements shown ordescribed (or one or more aspects thereof), either with respect to aparticular example (or one or more aspects thereof), or with respect toother examples (or one or more aspects thereof) shown or describedherein.

In the event of inconsistent usages between this document and anydocuments so incorporated by reference, the usage in this documentcontrols.

In this document, the terms “a” or “an” are used, as is common in patentdocuments, to include one or more than one, independent of any otherinstances or usages of “at least one” or “one or more.” In thisdocument, the term “or” is used to refer to a nonexclusive or, such that“A or B” includes “A but not B,” “B but not A,” and “A and B,” unlessotherwise indicated. In this document, the terms “including” and “inwhich” are used as the plain-English equivalents of the respective terms“comprising” and “wherein.” Also, in the following claims, the terms“including” and “comprising” are open-ended, that is, a system, device,article, composition, formulation, or process that includes elements inaddition to those listed after such a term in a claim are still deemedto fall within the scope of that claim. Moreover, in the followingclaims, the terms “first,” “second,” and “third,” etc. are used merelyas labels, and are not intended to impose numerical requirements ontheir objects.

The above description is intended to be illustrative, and notrestrictive. For example, the above-described examples (or one or moreaspects thereof) may be used in combination with each other. Otherembodiments can be used, such as by one of ordinary skill in the artupon reviewing the above description. The Abstract is provided to complywith 37 C.F.R. § 1.72(b), to allow the reader to quickly ascertain thenature of the technical disclosure. It is submitted with theunderstanding that it will not be used to interpret or limit the scopeor meaning of the claims. Also, in the above Detailed Description,various features may be grouped together to streamline the disclosure.This should not be interpreted as intending that an unclaimed disclosedfeature is essential to any claim. Rather, inventive subject matter maylie in less than all features of a particular disclosed embodiment.Thus, the following claims are hereby incorporated into the DetailedDescription as examples or embodiments, with each claim standing on itsown as a separate embodiment, and it is contemplated that suchembodiments can be combined with each other in various combinations orpermutations. The scope of the invention should be determined withreference to the appended claims, along with the full scope ofequivalents to which such claims are entitled.

The claimed invention is:
 1. A femoral head press comprising: a framehaving a first end and a second end; a clamp connected to the first endof the frame, the clamp defining a holding plane and the clampcomprising: a collar for attaching to a neck of a femoral stem; aninsert positioned in the collar for buffering against the collar,wherein the collar is configured to open to accept the insert andwherein the insert comprises: a socket configured to mate with the neckof the femoral stem; and exterior surfaces configured to mate with thecollar, wherein the exterior surfaces comprise: a first channelconfigured to receive a first mating portion of the collar; and a secondchannel configured to receive a second mating portion of the collar; anda tensioner including a first fastener extending through the collarconfigured to displace the insert within the collar along the holdingplane; a mechanical drive mechanism mounted to the second end of theframe, the mechanical drive mechanism having a drive axis, themechanical drive mechanism further comprising a ram connected to thesecond end of the frame; and a femoral head cup connected to the ram;wherein the mechanical drive mechanism is configured to drive the ramalong the drive axis substantially perpendicular to the holding plane toadvance the femoral head cup toward the clamp; wherein the clamp isconfigured to hold a center of the neck of the femoral stem parallel tothe drive axis; and wherein the tensioner is configured to position theinsert such that the center of the neck of the femoral stem aligns withthe drive axis.
 2. The femoral head press of claim 1, wherein the insertis made of a resilient material.
 3. The femoral head press of claim 1,wherein the insert is captured in the collar.
 4. The femoral head pressof claim 1, wherein: the clamp includes a second fastener for closingthe collar.
 5. The femoral head press of claim 4, wherein: the collarcomprises: a fixed jaw; and a rotatable jaw that is pivotable away fromthe fixed jaw to allow the collar to open to receive the insert; whereinthe second fastener is configured to extend through the fixed jaw andthe rotatable jaw to close the collar; and wherein the insert includes asplit configured to allow the insert to open to receive the neck of thefemoral stem.
 6. The femoral head press of claim 1, wherein the frameincludes a balance handle spaced from the mechanical drive mechanism. 7.The femoral head press of claim 1, wherein the femoral head cup includesfingers.
 8. The femoral head press of claim 1, wherein the mechanicaldrive mechanism includes a machine that produces a mechanical advantage.9. The femoral head press of claim 1, wherein the mechanical drivemechanism includes a motor.
 10. The femoral head press of claim 1,wherein the mechanical drive mechanism comprises a threaded engagementbetween the frame and the ram, and the ram further comprises a knob. 11.The femoral head press of claim 1, wherein the mechanical drivemechanism comprises: a lever arm having a first end and a second end,the first end coupled to the frame and the second end extending from theframe; a toothed gear coupled to the first end of the lever arm; and agear tooth track extending along the ram.
 12. The femoral head press ofclaim 1, wherein the mechanical drive mechanism comprises: a motorhaving a worm gear; a gear system; and a gear tooth track extendingalong the ram.
 13. The femoral head press of claim 1, furthercomprising: the femoral stem having the neck; and a femoral head havinga socket configured to mate with the neck of the femoral stem; whereinthe femoral stem is configured to mount in the clamp and the femoralhead is configured to mount in the femoral head cup such that the neckof the femoral stem and the socket axially align.
 14. The femoral headpress of claim 13, wherein the insert comprises: a socket configured tomate with the neck of the femoral stem; and exterior surfaces configuredto mate with the collar.
 15. The femoral head press of claim 1, furthercomprising a plurality of inserts, each of the plurality of insertshaving exterior surfaces that are shaped identically to mate with thecollar and sockets having interior surfaces that are shaped differentlyto mate with different femoral stems.
 16. The femoral head press ofclaim 1, herein the socket comprises: a curved forward surface; and aflat rear surface.
 17. The femoral head press of claim 1, wherein: theframe includes a first bore; and the insert further comprises anextension portion comprising a second bore configured to align with thefirst bore when the insert is positioned within the collar such that athird fastener can be positioned through the second bore and into thefirst bore.
 18. A femoral head press comprising: a frame having a firstend and a second end; a clamp connected to the first end of the frame,the clamp defining a holding plane and the clamp comprising: anadjustable collar for attaching to a neck of a femoral stem; a removableinsert positioned in the adjustable collar for buffering against theadjustable collar, the removable insert comprising: a socket configuredto mate with the neck of the femoral stem; and exterior surfacesconfigured to interlock with the adjustable collar; a mechanical drivemechanism mounted to the second end of the frame, the mechanical drivemechanism having a drive axis, the mechanical drive mechanism furthercomprising a ram connected to the second end of the frame; and a femoralhead cup connected to the ram; wherein the mechanical drive mechanism isconfigured to drive the ram along the drive axis substantiallyperpendicular to the holding plane to advance the femoral head cuptoward the clamp; and wherein the insert is one of a plurality ofinserts, each of the plurality of inserts having exterior surfaces thatare shaped identically to mate with the adjustable collar and socketshaving interior surfaces that are shaped differently to mate withdifferent femoral stems.
 19. A femoral head press comprising: a framehaving a first end and a second end; a clamp connected to the first endof the frame, the clamp defining a holding plane and the clampcomprising: a collar for attaching to a neck of a femoral stem, thecollar comprising: a fixed jaw; a rotatable jaw that is pivotable awayfrom the fixed jaw to allow the collar to open; and a first fastenerconfigured to extend through the fixed jaw and the rotatable jaw toclose the collar; an insert positioned in the collar for bufferingagainst the collar, wherein the insert includes a split configured toallow the insert to open to accept the neck of the femoral stem; and atensioner including a second fastener extending through the collarconfigured to displace the insert within the collar along the holdingplane; a mechanical drive mechanism mounted to the second end of theframe, the mechanical drive mechanism having a drive axis, themechanical drive mechanism further comprising a ram connected to thesecond end of the frame; and a femoral head cup connected to the ram;wherein the mechanical drive mechanism is configured to drive the ramalong the drive axis substantially perpendicular to the holding plane toadvance the femoral head cup toward the clamp; wherein the clamp isconfigured to hold a center of the neck of the femoral stem paralleltothe drive axis; and wherein the tensioner is configured to position theinsert such that the center of the neck of the femoral stem aligns withthe drive axis.